Provider Demographics
NPI:1801345160
Name:HUSTON, JANA (APN)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:JANA
Other - Middle Name:LYNNE
Other - Last Name:PETTY CORDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:600 S 13TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-353-9709
Mailing Address - Fax:309-353-0929
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-353-9709
Practice Address - Fax:309-353-0929
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily